The Prevalence of Coronary Artery Disease in Patients with End Stage Renal Disease at the Initiation of Dialysis and the Accuracy of Noninvasive Tests

Korean Journal of Nephrology 2007;26(3):327-333.

Young Rim Song, M.D.2, Seong Gyun Kim, M.D.1, Eun Jung Kim, M.D.1 Soo Jin Kim, M.D.1, Tae Jin Park, M.D.1, Young Su Song, M.D.1 Ji Eun Oh, M.D.1, Young Ki Lee, M.D.1, Jang Won Seo, M.D.1, Jong Woo Yoon, M.D.1 Ja-Ryong Koo, M.D.1, Hyung Jik Kim, M.D.1, Jun

Department of Internal Medicine & Kidney Research Institute1 Hallym University College of Medicine, Anyang, Korea Department of Internal Medicine²
Seoul National University College of Medicine, Seoul, Korea

투석을 시작하는 만성신부전 환자에서 관상동맥 질환의 유병률과 비침습적 선별검사의 임상적 유용성

송영림2 김성균1 김은정1 김수진1 박태진1 송영수1 오지은1 이영기1 서장원1 윤정우1 구자룡1 김형직1 노정우1

한림대학교 의과대학 내과학교실, 신장연구소1, 서울대학교 의과대학 내과학교실2

Abstract

Purpose : Coronary artery disease (CAD) is a major cause of mortality in chronic dialysis patients, and often occurs within the first year of dialysis. However, there is little evidence based on prospective trials in incident dialysis patients, and nobody knows which noninvasive test is best for screening the CAD in these patients. Therefore, we conducted this study to examine the prevalence of CAD and the accuracy of noninvasive tests that we can easil do for detection of CAD in incident dialysis patients. Methods : We evaluated the prevalence of CAD using resting ECG, 2D echocardiography, 99m Tc tetrofosmin single photon emission computed tomography(SPECT) and the accuracy of these noninvasive screening tests in all 84 incident dialysis patients from March 2005 to September 2006 at the Hallym University SH Hospital in Korea. Results : Of eighty-four patients, 23 (27.4%) had significant CAD. Fifteen (18.9%) patients had ischemic ECG change, and its positive predictive value and sensitivity were 66.7% and 45.0%, respectively. Resting 2D echocardiography had positive predictive value of 77.3%, sensitivity of 63.6% and lower specificity of 50.0%. 99m Tc tetrofosmin SPECT had positive predictive value of 73.3% and sensitivity of 73.3%. Conclusion : The prevalence of CAD in patients at the initiation of dialysis was 27.4%. 99m Tc tetrofosmin SPECT may be helpful for diagnosing CAD with ECG and 2D-echocardiography because of high sensitivity and positive predictive value.

Key Words: Chronic kidney failure, Coronary disease, Prevalence